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Suggest Treatment For Symptoms Of Orthostatic Hypotension
Question: I was in hospital this week with four syncope episodes, 1 Monday, 3 wed. They did MRI mon which showed a watershed stroke but review of a second MRI on thurs made them think stroke was old and not related. My blood pressure is low at times so they sent me home on fludrocortisone and told me to take a low dose aspirin daily for heart. However heart monitor, eeg, ekg, ct echo showed nothing for them to go on. Now I am home and feeling tired, sluggish, getting light-headed fairly often but have not passed out, mildly nauseous, headache, slight fever,slightly short of breath at times, no stroke symptoms (can raise arms equally, wiggly tongue, talk without sluring, smile) thyroid panel was run before I left, showed .32 which I guess is normal but low. They said to follow up with pcp, It just seems stuff is still not right. Any ideas
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Thank you for asking on HCM!
The presence of watershed stroke (even though old), indicates that you have episodes of low blood pressure.
Orthostatic hypotesion could be the cause of all this clinical scenario.
In fact fludocortisone is used to treat this disorder, even though you have not performed a Head Up Tilt test.
This is the golden standard test to rule in/ out this possible disorder.
I would recommend repeating thyroid hormone levels and also perform some other tests to exclude other possible causes:
- plasma levels of cortisol and aldosteron
- blood electrolytes
- inflammation tests (PCR, sedimentation rate) for a possible inflammatory disorder.
A close monitoring of your blood pressure in sitting and standing up position frequently during the day is necessary. You should write down those blood pressure values and refer them to your doctor.
Meanwhile, I would recommend taking plenty of fluids (water, juice) and increase salt intake.
Hope to have been helpful!
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Thank you for asking on HCM!
The presence of watershed stroke (even though old), indicates that you have episodes of low blood pressure.
Orthostatic hypotesion could be the cause of all this clinical scenario.
In fact fludocortisone is used to treat this disorder, even though you have not performed a Head Up Tilt test.
This is the golden standard test to rule in/ out this possible disorder.
I would recommend repeating thyroid hormone levels and also perform some other tests to exclude other possible causes:
- plasma levels of cortisol and aldosteron
- blood electrolytes
- inflammation tests (PCR, sedimentation rate) for a possible inflammatory disorder.
A close monitoring of your blood pressure in sitting and standing up position frequently during the day is necessary. You should write down those blood pressure values and refer them to your doctor.
Meanwhile, I would recommend taking plenty of fluids (water, juice) and increase salt intake.
Hope to have been helpful!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for this answer. Now on fludrocortisone a few days and it makes me feel awful, nausea, bloating, vomiting, colonoscopy-prep diarrhea. I took one pill each of first two days, down to 1/2 pill yesterday, had the diarrhea last night. I don't have lightheadedness when I am so nausous and bloated, in evenings (take pill around 3pm with food). But I do have normal blood pressure earlier in day (avg 115)...when I still feel light-headed. In evenings I don't feel lightheaded and have high blood pressure 120 to 130...but am feeling horrible so high pb not too surprising. Just trying to figure out if there is something different I can do (I have increased salt and added a Gatorade a day) instead of med that is making me so sick and I don't really know if the low pb is causing lightheadedness, since pb when I have lightheadJess is in normal range or high 90s. Thanks.
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello again!
Thank you for the additional information.
Unfortunately there is not too much you can do in case of orthostatic hypotension.
Increasing salt and caffeine intake is very helpful.
Equipment aids may be helpful. These include tight support stockings, abdominal binders, or antigravity suits for symptomatic hypotension.
Anyway, I recommend performing the above recommended tests to investigate for the possible underlying cause (adrenal gland dysfunction, electrolyte imbalance).
Avoiding prolonged standing up position and change your position gradually when standing up, will help avoid lightheadedness or falling.
If you do not tolerate fludocortisone, you can switch to Midodrine or Droxidopa. Another treatment option would be Desmopressin.
You should discuss with your doctor on the above issues.
Hope to have clarified some of your uncertainties!
Best wishes,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello again!
Thank you for the additional information.
Unfortunately there is not too much you can do in case of orthostatic hypotension.
Increasing salt and caffeine intake is very helpful.
Equipment aids may be helpful. These include tight support stockings, abdominal binders, or antigravity suits for symptomatic hypotension.
Anyway, I recommend performing the above recommended tests to investigate for the possible underlying cause (adrenal gland dysfunction, electrolyte imbalance).
Avoiding prolonged standing up position and change your position gradually when standing up, will help avoid lightheadedness or falling.
If you do not tolerate fludocortisone, you can switch to Midodrine or Droxidopa. Another treatment option would be Desmopressin.
You should discuss with your doctor on the above issues.
Hope to have clarified some of your uncertainties!
Best wishes,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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